For millions of older adults and people with disabilities, direct care workers are a lifeline. These workers provide essential support with daily activities like bathing, dressing, and meal preparation, helping many live safely and independently. Direct care workers are the backbone of our long-term care system.
What’s less recognized are the persistent challenges these workers face on the job and in their daily lives—and the many interventions that could support their economic well-being. As our country ages, so too does this workforce. One in four direct care workers are 55 or older, offering a wealth of experience that could benefit the field. But tapping into this potential requires addressing the systemic barriers that many older workers face.
Our organizations, The John A. Hartford Foundation and National Skills Coalition, are committed to strengthening this workforce, ensuring that both caregivers and recipients receive the support they deserve, and advancing a better reality for everyone as they age.
Direct care workers include more than 5 million home health aides, personal care aides, and certified nursing assistants—making this larger than any other single occupational group in the country. They provide hands-on assistance while also offering emotional, physical, and increasingly clinical support. Too often, they are perceived as low-skilled, when in reality, well-trained direct care workers develop a broad range of competencies to succeed.
Beyond meeting basic living needs, these workers play a vital role in delivering age-friendly, person-centered care. They help individuals manage chronic conditions, navigate complex healthcare systems, and maintain independence. In doing so, they often become trusted allies, forming long-term relationships with the people they serve and their families.
Despite their importance, direct care jobs remain undervalued. Wages are typically poverty-level and not competitive, hours are often part-time, and access to training and advancement is severely limited. Home care jobs can be isolating and physically risky, while nursing assistants face some of the highest injury rates in the entire workforce. Supportive services and worker protections are often unavailable. While some states have made progress, most have not invested nearly enough in such an essential workforce.
As the U.S. population has rapidly aged, so too has the direct care workforce. More than one in four direct care workers (28%) is 55 or older, reflecting a growing trend of older individuals entering or remaining in these jobs. More broadly, many older people are working longer out of choice and necessity, with people aged 75 and older being the fastest-growing age segment in the entire U.S. workforce.
This shift underscores the need for targeted investments. Many older adults take on or remain in paid caregiving roles because of flexible schedules, prior experience caring for family members, or a desire to support others. Older workers bring their life experience, commitment, and reliability to caregiving—qualities that enhance the quality of care. Yet many face increased economic and physical challenges. Many cannot achieve financial security due to low wages and lack of retirement benefits. . , long-term care and other sectors will suffer without stronger pipelines and improved job quality. Moreover, immigration restrictions are likely to further exacerbate the direct long-term care workforce.
The need for direct care is growing rapidly. Over the next few decades, the number of Americans aged 65 and older will increase by 47%—from 58 million in 2022 to 82 million in 2050. At the same time, care needs are becoming more complex, with rising rates of dementia, chronic illness, and multiple health conditions requiring specialized skills. Yet as demand grows, so does turnover. In some settings, annual turnover reaches nearly 80%, fueled by poor compensation, limited career mobility, and difficult working conditions. Between 2022 and 2032, nearly 9 million direct care job openings will need to be filled, including new roles and replacements for those leaving the field.
To address this moment, we must improve job quality, training, and career advancement for direct care workers, especially older workers. Raising wages, expanding access to paid leave, and offering retirement benefits would also make these jobs more competitive and sustainable. No one should have to choose between caregiving and financial stability. That’s why National Skills Coalition recently launched a new initiative focused on improving the training, career pathways, and workforce development needs of both direct care and childcare workers.
Robust training programs—including specialized skills like dementia care—would help workers grow in their roles and move into more senior positions. Clear career ladders can transform direct care from a stopgap job into a respected profession.
Given that many direct care workers are older adults, it’s essential to ensure they have the right support to stay healthy, safe, and fulfilled on the job. Aging advocates have called for flexible schedules and job accommodations to reduce physical strain. Equally important is access to preventive health care, mental health services, and support for managing chronic conditions, which intensify with age.
Older workers also benefit from continued training and advancement opportunities that help them adapt to an evolving economy. Protections against age discrimination and accommodations for age-related needs are essential to fostering inclusion. Financial planning resources and phased retirement options can also help older workers transition out of the workforce with dignity. By cultivating a workplace culture that values their contributions, we help this vital workforce thrive. And we boost the economy.
Moreover, many direct care workers first enter the field after caring for family members—and between direct care workers and family caregivers is critical. Structured pathways to transition from unpaid caregiving into formal employment would benefit both these individuals and the care system overall. Enabling care recipients to select and direct their caregivers, including family members, can expand the available workforce at this critical time of need. Recognizing family caregivers and direct care workers as part of interdisciplinary care teams—with proper training—would help meet growing demand. Matching service registries can also help connect trained caregivers with families in need, easing shortages and improving job placement.
There is growing recognition of the role that direct care workers play. For example, the National Strategy to Support Family Caregivers, the first-ever comprehensive framework to support caregivers, led to new funding for a Direct Care Workforce Strategies Center to strengthen professional development and support for paid caregivers. Direct care workers are central to the future of aging in America and many are aging themselves. Strengthening this workforce is not just about supporting workers—it’s about ensuring high-quality, reliable care for millions of older adults and people with disabilities.
Improving job quality, training, and career pathways will benefit workers, families, and the entire health care system. Policymakers, employers, and advocates must act now to invest in the solutions that will stabilize and elevate this essential workforce, including interventions that support older workers.
The John A. Hartford Foundation is proud to support these efforts, including through its sponsorship of National Skills Coalition’s 2025 Skills Summit, where leaders across sectors are working to advance policies that strengthen the caregiving workforce.
Aging well depends on the workers who make it possible. It’s time we invest in them.
Read National Skills Coalition’s new issue brief on older and younger workers.
The John A. Hartford Foundation is a Supporting Sponsor at this year’s Skills Summit.
